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An overview of stomach cancer
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Stomach cancer
☼ An Overview
Distributed under Creative Commons license
☼ Introduction
• leading cause of cancer related morbidity
• Second most common cause of cancer related
deaths after Lung cancer (10.4% of all cancer related deaths).
• 60% cases occur in the developing world • linked to dietary habits and unhealthy food
preservation practices
☼Causes-
• A/S/L- Elderly Male Asians and East Europeans.
• Diet- Food preserved by drying, smoking, salting and
pickling Dietary nitrites converted to carcinogenic N-nitroso compounds by bacteria in the
stomach.
• Helicobacter Pylori infection-People with H. Pylori bacteria infection of the stomach have greater risk.
Causes- contd
• Prior stomach surgery-People with a history of stomach surgery face a greater risk due to alteration in normal ph of the stomach.
• Stomach Disorders- Pernicious anemia, achlorhydria and atrophic gastritis 6 times more prone.
• Smoking
• Hereditary- underlying genetic factors are poorly understood (KRAS mutation, c-met amplification)
Rarely, some gastric ulcers may turn into cancer.
☼ Types
• 90% arise from the glandular cells of the stomach wall and are called Adenocarcinomas.
• Others – Gastric Lymphomas (cancer of gastric lymphatic tissue) Soft tissue sarcomas (e.g. Leiomyosarcomas) Carcinoids
☼Clinical features • Early stages asymptomatic.
• non-specific symptoms like indigestion, nausea, vomiting and sometimes Pain.
• bloated feeling after eating, loss of appetite, dark colored stools (due to presence of blood) and feeling of tiredness (due to anemia).
• Late features- peritoneal and pleural effusions, Jaundice and cachexia.
• Hepatomegaly usually occurs and presence of an enlarged left supraclavicular lymphnode (Virchow's sign) is a typical finding.
☼Treatment• Surgical intervention Partial/subtotal gastrectomy , Total gastrectomy + making of a new stomach
from S.I
• Radiation therapy- external beam radiation (5 days/week*6 to 8
weeks). Tomotherapy HI-ART (Tomotherapy highly
integrated adaptive radiotherapy) for specific reduced doses.
• Chemotherapy – 5 fluorouracil, Cisplatin, Doxorubicin.
• Immunotherapy
☼ Prognosis
• Indicators - Stage - Tumor Size - Histological Type - Degree of cytological atypia - Lymphatic/vascular invasion
• Generally, five year survival is a poor 30%.
• Younger patients have more aggressive disease.
Dr. Neelesh Bhandari MBBS(A.F.M.C), MD (Path.)
PGP Human Rights.